Is your therapist trained to address your needs?
Kindness of both friends and strangers is a theme running through many cancer journeys. Generosity is often delivered in the form of gift baskets dropped at the door, cards, prayers, and, sometimes, a gift certificate for a massage at your local–no, wait! That well-intended “luxury” rub-down performed by a therapist not trained in oncology massage could do real harm.
Spend time with any qualified oncology massage therapist, either in a hospital or an out-patient setting, and you’ll experience many techniques performed on your feet, back, hands, and head meant to soothe and comfort. It looks easy enough; however, as important as what is performed on your body is the therapist’s knowledge of what not to do. A qualified oncology massage therapist also performs many seemingly simple yet complicated techniques on the body based on her knowledge of the way the patient’s cancer is affecting her body and her awareness of the effects of the related treatment.
In-patient and out-patient oncology massage techniques have been studied and are now accepted and respected in most major hospital systems thanks to the hard work of pioneers in the field like Gayle MacDonald, Cheryl Chapman, Tracy Walton, Janet Post-White, Janet Kahn, and Cynthia Myers. From major healthcare systems like Memorial Sloan-Kettering to 220-bed hospitals like Benedictine Hospital in Kingston, New York, oncology massage is offered to oncology patients at every step of their journey.
It is my years of experience in a clinical setting that lead me time and again to urge oncology patients to be careful and wise before allowing themselves to be massaged by anyone who is not specially trained in oncology massage. From the moment you are diagnosed with any form of cancer and as you move through treatment and beyond, your body will always need special care. Well beyond full recovery, you must use caution in your choice of massage therapists.
First, let’s discuss why your massage must be performed by a specially trained therapist; second, we’ll cover a list of questions you should be prepared to ask before allowing a therapist to begin a massage; and, finally, we’ll describe the steps you can take to locate a qualified therapist.
So, what is it about going through cancer that demands such special attention during a massage?
If you’ve experienced recent surgery (from the minor insertion or removal of a mediport to a full mastectomy or TRAM reconstruction), you should be aware of the following:
- Your wounds must be clean and dry before any touch is performed.
- Tissue integrity must be examined to assure that unhealed subcutaneous tissue is not pulled or tugged.
- Scars must be examined for integrity (no stitches left behind, no openings for the entrance of bacteria, no tiny sites of infection or redness).
If you are receiving chemotherapy:
- You must not have a full-body regular massage the day of or the day after infusion. If you do,you will end up feeling very ill and may experienceflu-like symptoms.
- The therapist should not work anywhere near or on the infused arm (if you do not have a port).
- She must know the location of the port and how it works so as not to compromise the device.
- She should know enough to ask if you are experiencing any neuropathy—depending upon the type of chemo you are receiving—and then have some suggestions for techniques tohelp relieve tingling hands and feet. (However, this is a very new technique and not available to most therapists in the country at this time; you won’t be harmed if your therapist does not know this technique.)
If you are receiving radiation:
- Your therapist must know to not use lubricant or powder on neither the entrance nor the exit radiation sites.
- She should know how to soothe first-degree or early second degree reddening of the skin with cool water compresses only (nothing else should be used).
- She must know not to use any lubricants or powders during the entire radiation treatment regimen and for two weeks beyond.
If you’ve lost lymph nodes (either in your arm pit or groin):
- (We’ll use breast cancer as an example.) For the rest of your life, no deep pressure is to be applied to the affected quadrant; no deep pressure on the entire arm, upper chest, upper back, and shoulder region. Too much pressure can bring on lymphedema symptoms.
- The therapist should know enough about the risk of lymphedema (particularly with breast cancer patients) to counsel you that for the rest of your life, you must always wear a compression sleeve on your affected arm whenever you fly.
Oncology massage training assures that your therapist will:
- not create lymphedema
- not mobilize a deep vein thrombosis (blood clot)
- not compromise your possible immunosuppressed state
- not send chemotherapy through your body more quickly than intended
- not over-tax your already exhausted body
If you’re nervous about getting a massage, keep in mind that receiving a massage during cancer treatment can have profound positive effects. A qualified therapist has training in the following areas, all of which concern your safety and well-being:
- How long and to what depth to work if you received chemotherapy today or yesterday
- Special techniques if you are at the end of your journey and in hospice care
- The importance of helping to improve your arm and shoulder range of motion (if you’ve experienced breast cancer)
- Techniques to help scars in any location heal
- How to embrace your journey with you and help improve your body image and your self-esteem
What Oncology Experts Say
Dana Zakalik, MD, Director of the Cancer Genetics Program at Beaumont Hospitals in Michigan, says of oncology massage, “Many patients can benefit significantly from massage therapy, both for symptom management and improvement of well-being, which plays a critical role in the patient’s recovery from cancer treatment.”
“We’ve gotten an overwhelming positive response to the massage service,” says oncology nurse clinician Cheryl Bartley from the Beaumont Royal Oak system. “It helps the patients relax, decreases their anxiety, makes them feel generally better, especially with tolerating their pain. Patients express gratitude for this service all the time; it’s been wonderful.”
And from highly regarded radiation oncologist, Frank Vicini, MD, FACR, Beaumont Hospital’s Chief of Oncology: “We have found massage therapy to lend itself not only as a tool for effective comfort care for our oncology patients, but as a modality that we intend to investigate regarding its evidence-based efficacy for long-term use in our cancer population.”
If you’d like to do your own research, enter any of the above names, including mine (Charlotte Michael Versagi, LMT, NCTMB), in your Internet search engine and you’ll find a wealth of information about oncology massage training programs, techniques, and available research.
When you are ready for a full-body massage and you want to interview your massage therapist, here are some important and helpful questions:
- Are you specially trained in oncology massage? (If she says, “I treat cancer patients all the time,” repeat the question. She could be treating incorrectly or without training.)
- Where did you receive your training? (Was it a one-day lecture or did she train with one of the half-dozen respected authorities in the country and get extensive lectures and hands-on training?)
- Which precautions will you take with me as a cancer patient? I’ve had 10 lymph nodes removed (for example) from my arm pit. (She should understand that without modified pressure on the arm and entire quadrant, she could create lymphedema. She should at least know the word lymphedema. If not, flee.)
- Do you know how to perform scar work and tissue mobilization if I have limited range of motion?
- If I’m immunocompromised, what precautions will you take?
This may sound like unnecessary grilling to receive a simple massage, but it’s actually critical information. Just re-read the above bulleted lists of your risks at the hands of an untrained therapist and you will realize the importance of interviewing your massage therapist.
The following resources can help you find a qualified oncology massage therapist:
- The Web site www.amtamassage.org has a locator service that allows you to search by state and then city for therapists with specialties.
- Call any local cancer center and ask if they refer to “qualified oncology massage therapists”.
- Gayle MacDonald or Tracy Walton’s Web sites (www.medicinehands.com and www.tracywalton.com, respectively) will give you contact information to help you find a qualified therapist. They train all over the country.
The many benefits of a massage include decreased anxiety, an increase of body-acceptance, decrease in insomnia, increased range of motion, decrease of adhesions, and a sense of peace. Take advantage of this wonderful service but, just as you have throughout your cancer experience, ask the right questions first. You will then be able to enjoy the full benefits of this amazing holistic modality.